Diabetes and Cardiovascular Disease During Androgen Deprivation Therapy: Observational Study of Veterans With Prostate Cancer
Diabetes and Cardiovascular Disease During Androgen Deprivation Therapy: Observational Study of Veterans With Prostate Cancer
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DOI：
10.1093/jnci/djp404
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发表时间：
2010-01-06
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影响因子：
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通讯作者：
Smith, Matthew R.
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作者：
Keating, Nancy L.;O'Malley, A. James;Smith, Matthew R.
先前的研究表明，前列腺癌的雄激素剥夺疗法与老年男性的糖尿病和心血管疾病有关。我们评估了所有年龄段患有前列腺癌的男性的雄激素剥夺疗法与入口糖尿病与心血管疾病之间的关系。我们对37443名基于人群的男性进行了观察性研究，这些男性被诊断为局部或区域性前列腺癌，来自退伍军人医疗保健的局部或区域性癌症。 2001年1月1日，截至2004年12月31日，随访至2005年12月31日。COX比例危害模型用于评估雄激素剥夺治疗是否伴有促性腺激素释放激素（GNRH）激素，口服抗雄激素的组合在调整患者和肿瘤特征后，两个（IE，雄激素阻断术）或提供果切除术与糖尿病，冠心病，心肌梗死，心肌死亡或中风有关。所有统计检验均为双向。替代，在37443例患者中，有14 597（39％）接受了雄激素剥夺治疗。用GNRH激动剂治疗与统计学上显着增加了事件糖尿病的风险（对于GNRH激动剂疗法，每1000人年的159.4个事件与无雄激素剥夺治疗的87.5事件，差异= 71.9，71.9，95％置信区间[CI]至71.6 = 71.6 = 71.6 = 71.6 = 71.6 = 71.6 = 71.6 = 71.6 72.2;调整危险比[AHR] = 1.28，95％CI = 1.19至1.38），事件冠心病（AHR = 1.19，95％CI = 1.10至1.28）激动剂治疗与7.3 no雄激素剥夺治疗，差异= 5.5，95％CI = 5.4至5.6; AHR = 1.28，95％CI = 1.08至1.52），猝死）和中风（AHR = 1.22，95％CI = 1.10至1.36）。联合雄激素阻断在统计学上与出现冠心病的风险增加（AHR = 1.27，95％CI = 1.05至1.53），并且与冠状动脉疾病有关（AHR = 1.40，95％CI = 1.04至1.87至1.87 ）和心肌梗塞（AHR = 2.11，95％CI = 1.27至3.50）。口服抗雄激素单一疗法与所研究的任何结果无关。用GNRH激动剂及其剥夺疗法与糖尿病和心血管疾病的风险增加有关。
Previous studies indicate that androgen deprivation therapy for prostate cancer is associated with diabetes and cardiovascular disease among older men. We evaluated the relationship between androgen deprivation therapy and incident diabetes and cardiovascular disease in men of all ages with prostate cancer.We conducted an observational study of 37 443 population-based men who were diagnosed with local or regional prostate cancer in the Veterans Healthcare Administration from January 1, 2001, through December 31, 2004, with follow-up through December 31, 2005. Cox proportional hazards models were used to assess whether androgen deprivation therapy with gonadotropin-releasing hormone (GnRH) agonists, oral antiandrogens, the combination of the two (ie, combined androgen blockade), or orchiectomy was associated with diabetes, coronary heart disease, myocardial infarction, sudden cardiac death, or stroke, after adjustment for patient and tumor characteristics. All statistical tests were two-sided.Overall, 14 597 (39%) of the 37 443 patients were treated with androgen deprivation therapy. Treatment with GnRH agonists was associated with statistically significantly increased risks of incident diabetes (for GnRH agonist therapy, 159.4 events per 1000 person-years vs 87.5 events for no androgen deprivation therapy, difference = 71.9, 95% confidence interval [CI] = 71.6 to 72.2; adjusted hazard ratio [aHR] = 1.28, 95% CI = 1.19 to 1.38), incident coronary heart disease (aHR = 1.19, 95% CI = 1.10 to 1.28), myocardial infarction (12.8 events per 1000 person-years for GnRH agonist therapy vs 7.3 for no androgen deprivation therapy, difference = 5.5, 95% CI = 5.4 to 5.6; aHR = 1.28, 95% CI = 1.08 to 1.52), sudden cardiac death (aHR = 1.35, 95% CI = 1.18 to 1.54), and stroke (aHR = 1.22, 95% CI = 1.10 to 1.36). Combined androgen blockade was statistically significantly associated with an increased risk of incident coronary heart disease (aHR = 1.27, 95% CI = 1.05 to 1.53), and orchiectomy was associated with coronary heart disease (aHR = 1.40, 95% CI = 1.04 to 1.87) and myocardial infarction (aHR = 2.11, 95% CI = 1.27 to 3.50). Oral antiandrogen monotherapy was not associated with any outcome studied.Androgen deprivation therapy with GnRH agonists was associated with an increased risk of diabetes and cardiovascular disease.